Real-world data analysis of the utilization of second-line maintenance therapy for patients with advanced ovarian cancer.

Abstract

e18702 Background: Although ovarian cancer (OC) represents about 1% of all new cancer cases in the US, it is the 5th leading cause of cancer death among women. Several maintenance therapies have been introduced (ie, bevacizumab and poly[ADP-ribose] polymerase inhibitors [PARPi]) to extend the time between chemotherapy and relapse (ie, progression-free survival) in this population. Both bevacizumab and PARPi have been recommended as second-line (2L) maintenance treatment by the National Comprehensive Cancer Network for OC patients (pts) with and without BRCA alterations since 2013 and 2017, respectively. We present recent estimates of 2L maintenance utilization. Methods: From the iKnowMed electronic health record database of the US Oncology Network, which includes 1,200 physicians operating in over 470 sites of care in the US, adult females were included if diagnosed with advanced OC, received a 2L platinum-containing regimen for advanced OC, and had ≥2 visits within the database between 1 Jan 2016 and 31 July 2020. Pts were followed longitudinally until 31 Oct 2020, the last pt record, or date of death, whichever occurred earliest. Rates of 2L maintenance therapy (ie, bevacizumab monotherapy or PARPi following discontinuation of 2L platinum-based chemotherapy) were determined for 1) all pts, 2) pts with a BRCA1 or BRCA2 gene alteration (BRCA+), and 3) pts without a BRCA alteration (BRCA-). Results: 11,494 pts were identified with a diagnosis of advanced OC; of those, 1,051 met the study inclusion criteria. Median age at advanced OC diagnosis was 64.2 years. Median follow-up time from discontinuation of 2L platinum chemotherapy until the end of observation was 24.6 mo. Of 1,051 pts who received 2L platinum-based chemotherapy, 513 (49%) subsequently received maintenance therapy (271 [26%] PARPi, 294 [28%] bevacizumab, 32 [3%] a non-platinum chemotherapy) and 538 (51%) did not receive maintenance (ie, underwent “active surveillance”). The proportion of eligible pts receiving 2L maintenance did not increase over the study period, with 53%, 58%, and 56% of pts receiving 2L maintenance versus 47%, 42%, and 44% of pts undergoing active surveillance in the years 2017, 2018, and 2019, respectively. Among the 1,051 pts who received 2L platinum chemotherapy, 662 pts had a documented BRCA test result (94 [14%] BRCA+, 568 [86%] BRCA-). Among BRCA+ pts, 67% received 2L maintenance, while BRCA- pts received significantly less maintenance treatment (53%, p = 0.0104). Conclusions: Despite having several treatment options available for 2L advanced OC maintenance, fewer than half of eligible pts receive maintenance treatment. Although the utilization rate was higher among pts with BRCA alterations versus those without, our data suggest that there is a significant proportion of eligible pts who are not receiving maintenance therapy despite treatment guideline recommendations.